What is hoarding behavior in dementia patients?

According to the National Institute of Health, hoarding is a relatively common behavior in dementia patients, affecting over 20% in some populations. This behavior, characterized by the excessive collection and inability to discard items, can be a distressing symptom for families and caregivers trying to understand and manage their loved one's condition.

Quick Summary

Hoarding behavior in dementia patients involves the compulsive accumulation of objects, often of little or no value, stemming from cognitive decline and heightened anxiety. It can be a coping mechanism for memory loss or a perceived need for control, potentially leading to unsafe living conditions.

Key Points

• Symptom of Dementia: Hoarding in dementia is a symptom of cognitive decline, not a standalone personality flaw, often linked to memory loss and confusion.

• Safety over Tidiness: Prioritizing the removal of immediate safety hazards, such as fire risks or trip hazards, is more important than achieving a perfectly tidy home.

• Emotional Cause: The behavior often stems from a person's need for security and control in a world that is becoming more confusing to them.

• Manage with Compassion: Confronting a person with dementia about their hoarding can cause severe distress; a gentle, compassionate approach is most effective.

• Creative Solutions: Tools like 'memory boxes' or backup copies of essential items can help manage the behavior without causing upset.

• Seek Professional Help: If hoarding creates an unsafe environment, consulting a doctor or a specialist is crucial for personalized strategies and support.

Understanding Hoarding in the Context of Dementia

Hoarding behavior is a complex issue, and when it arises in an individual with dementia, it adds another layer of complexity. Unlike a standalone hoarding disorder, which often begins earlier in life, dementia-related hoarding is typically linked to the cognitive and emotional changes occurring due to the disease. The person is not simply 'being difficult'; their brain is literally changing, affecting their judgment, memory, and sense of security. This behavior can manifest in various ways, from collecting seemingly useless items like trash or old newspapers to accumulating duplicates of new items.

Why Hoarding Occurs with Dementia

There are several reasons why dementia patients may start to exhibit hoarding behaviors. The root causes are deeply tied to the neurological and psychological effects of cognitive decline. Understanding these reasons is the first step toward effective and compassionate management.

• Memory Loss: As a person's short-term memory deteriorates, they may forget that they have already purchased an item or put it away. This can lead to the acquisition of multiple duplicates, such as cans of shaving cream or bags of sugar. They may also hide items for 'safekeeping' and then forget where they put them, leading to further anxiety.
• Search for Security and Control: The progressive loss of control over one's own life is a terrifying aspect of dementia. Hoarding can be an attempt to regain a sense of control and create a secure environment. Their possessions become a physical tether to reality, and parting with them feels like losing another part of themselves.
• Difficulty with Decision-Making: The cognitive impairment caused by dementia affects executive functions, including the ability to organize, plan, and make decisions. A person may simply lose the mental capacity to sort through mail or throw away junk, leading to an accumulation of clutter. They may also be unable to differentiate between what is valuable and what is not.
• Heightened Anxiety and Paranoia: Feelings of insecurity can lead to paranoia, where a person with dementia believes others are trying to steal their belongings. This can cause them to stash items in unusual places or become defensive and agitated when caregivers try to declutter.
• Emotional Attachment: An item may hold a significant emotional memory for the person, and the fear of losing that memory prompts them to keep the object. Even if the item is broken or has no value to others, it is priceless to them.

Practical Strategies for Managing Hoarding

Managing hoarding in a loved one with dementia requires patience, creativity, and a focus on safety over absolute tidiness. Rather than confronting the person directly, which can cause distress, use gentle and compassionate techniques.

1. Prioritize Safety First: Assess the home for immediate hazards. This includes blocked walkways that could cause falls, fire risks from clutter near heat sources, and spoiled food that could lead to illness. Address these critical issues first, and don't worry about non-hazardous clutter immediately.
2. Create 'Memory Boxes': Designate a specific, special box for the person to keep their most cherished items. Involving them in decorating the box can make them feel more in control. This can help contain the clutter to one area and satisfy their need to collect.
3. Use Creative Diversions: Engage the person in activities that can redirect their compulsive behaviors. Sorting photographs, organizing a smaller collection of items, or engaging in simple crafts can provide a sense of purpose and minimize their focus on collecting new things.
4. Secure Valuables: Keep important documents, money, and valuables locked away to prevent them from being hidden or misplaced. You can use a lockbox or secure a spare room. This is also important for medications, which can be improperly managed or hoarded.
5. Remove Items Discretely: If the hoarding is minor and non-hazardous, it may be possible to remove some items gradually and discreetly over time, especially if their memory is significantly impaired. However, this must be done with extreme care to avoid causing distress. For severe cases, consider involving a professional organizer who specializes in hoarding and dementia.
6. Find the Triggers: Pay attention to when the hoarding behavior is most likely to occur. It could be triggered by boredom, anxiety, or a change in routine. Identifying these triggers can help you intervene with a distraction or reassurance before the behavior escalates.

Hoarding in Dementia vs. Hoarding Disorder

While the behaviors may appear similar, there are crucial distinctions between hoarding in dementia and a primary hoarding disorder. These differences impact the approach to management.

Feature	Hoarding in Dementia	Primary Hoarding Disorder
Onset	Later in life, alongside cognitive decline.	Typically begins in adolescence or early adulthood.
Insight	Lacks awareness of the problem; often believes their behavior is logical and necessary.	May be aware that the behavior is problematic, but struggles to stop.
Motivation	Driven by cognitive changes like memory loss, disorientation, and search for security.	Fueled by strong emotional attachments, perfectionism, or anxiety unrelated to cognitive decline.
Emotional Reaction	May experience anger, paranoia, or fear if confronted or if items are removed.	High distress and anxiety associated with discarding items.
Treatment Focus	Management strategies centered on safety, behavior modification, and compassionate care.	Often requires cognitive-behavioral therapy (CBT) and other psychological interventions.

For more information on hoarding disorder in general, visit the Anxiety & Depression Association of America.

Conclusion

Hoarding behavior in dementia is not a sign of personal failure or stubbornness, but a symptom of a progressive disease. By approaching the situation with empathy, understanding the underlying causes, and implementing safe, compassionate strategies, caregivers can manage the behavior and ensure a safer, calmer environment for their loved one. Remember to prioritize the individual's emotional security over a perfectly clean home, and to seek professional guidance when necessary to protect their health and well-being.

Frequently Asked Questions

What is hoarding behavior in dementia patients?

It is the compulsive accumulation and inability to discard items, often of little or no value, stemming from cognitive and emotional changes caused by dementia.

Is hoarding a normal part of aging?

No, hoarding is not a normal part of aging. While some people may become more attached to items, excessive hoarding in late life can be a sign of underlying cognitive decline or dementia.

What causes a dementia patient to hoard?

Common causes include memory loss (forgetting they own an item), a need for control and security, difficulty with decision-making, and heightened anxiety or paranoia.

How can I tell the difference between collecting and hoarding in a dementia patient?

The key difference is organization and safety. A collector's items are usually well-organized and accessible, whereas a hoarder's items are chaotically stored and often create unsafe living conditions.

What should I do if a loved one with dementia starts hoarding?

Focus on ensuring their safety first by clearing hazardous items. Use patience and compassion, and consider strategies like 'memory boxes' or creating engaging activities to redirect their focus.

Should I secretly throw out a dementia patient's hoarded items?

This is generally not recommended, as it can cause severe distress, paranoia, and damage trust. If small, non-hazardous items can be removed discreetly without being noticed, it may be possible, but direct confrontation or large-scale removal should be avoided.

Can medication help with hoarding behavior in dementia?

In some cases, a doctor might prescribe medication, such as anti-psychotics or anti-depressants, to help manage associated anxiety and compulsions. You should always consult a physician before pursuing this option.